Temporary risk identification in urolithiasis.

We have been using a risk index calculation for urolithiasis, which included most of the identifiable factors promoting calculogenesis. However, it was observed that the frequency of a patient getting stone problem was not uniform in spite of similarity of the risk index in the permanent setting. Also, many of the risk indices could be changed by dietary or lifestyle modifications. The objective of this paper was to calculate the temporary risk index of a patient at the time of each visit and correlate with stone activity during such periods, so that appropriate advice could be given on drugs, diet and lifestyle changes. The temporary risk index score was based on four symptoms, namely pain (0, nil; 1, vague pain; 2, mild; 3, moderate; 4, severe; 5, excruciating), haematuria (0, nil; 1, turbid; 2, cloudy; 3, reddish; 4, occasional frank blood; 5, continuous frank blood), burning sensation (0, nil; 1, minimal; 2, moderate; 3, terminal severe; 4, occasional excruciating; 5, continuous excruciating), and dysuria (0, nil; 1, minimal; 2, moderate; 3, terminal severe; 4, occasional excruciating, 5, continuous excruciating), ultrasonography for back pressure (0, nil; 1, mild; 2, moderate; 3, severe kidney and ureter; 4, unilateral total; 5, bilateral total anuria) and eight urine deposit findings (0, nil; 1, +; 2, 2+; 3, 3+; 4, 4+; 5, plenty), red blood cells, pus cells, whewellite crystals, weddellite crystals, phosphate crystals, uric acid/ammonium urate crystals, crystal clumping and crystal aggregation making a total of 13 parameters. Each parameter was given values ranging from 0 to 5. The total score was calculated and chemotherapeutic regimes were decided base on the score, which varied from 0 to 65. Hundred randomly selected patients who had been visiting the stone clinic for a minimum of five occasions were included in the study. The total scores of temporary risk were correlated with the permanent clinical risk score mentioned earlier. The temporary risk of the 100 patients during the total of 500 visits ranged from 0 to 43 out of 65. The risk score reduced significantly from visit 1 to 5 in all the patients. On correlating the mean index of the five visits with the permanent risk index, the correlation coefficient r value was +0.39 (P < 0.01). It was observed that patients go through periods of hyperactivity of stone metabolism and present with symptoms, producing temporary phases of overactivity. It is concluded that temporary risk index is correlatable with the permanent risk index of the patients forming urinary stones. It can be used as a method for scientific prediction regarding future stone formation in any individual. The dose of drugs and need for continuing chemotherapy for patients should be based on the temporary risk index. The blind prescription of drugs should be discouraged.